NATIONAL INSTITUTE ON DRUG ABUSE EPIDEMIOLOGIC ...

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236 are not estimates for the reporting area. Data are utilized for descriptive purposes only. Drug reports exceed the number of ED visits, since a patient may report use of multiple drugs (up to six drugs plus alcohol). Data cannot be compared to DAWN data from 2002 and before, nor can preliminary data be used for comparison with future data. Only weighted data released by OAS may be used for trend analyses. The first year of weighted data will be 2004, so reasonable trend analyses will not be possible for several years. Available data are for King and neighboring Snohomish Counties combined. ED race/ethnicity is not reported because 63 percent of drug abuse/other cases do not have race/ethnicity documented. There are new case types in DAWN, with the primary one presented here being the “other” case type, which includes “all ED visits related to recreational use, drug abuse, drug dependence, withdrawal, and any misuse” not classified in other categories, such as overmedication and seeking detox/treatment. For the sake of clarity, “other” will be referred to as “drug abuse/other” in this report. Unless specifically stated, data presented are for the drug abuse/other case type. Much of the discussion focuses on abuse of “illegal” drugs (e.g., cocaine, heroin, marijuana) as distinct from nonmedical use of prescription-type drugs and use of overthe-counter drugs and alcohol. A full description of the DAWN system can be found at the DAWN Web site . • Treatment data were extracted from the Washington State Department of Social and Health Services, Division of Alcohol and Substance Abuse’s Treatment and Assessment Report Generation Tool (TARGET) via the Treatment Analyzer system. TARGET is the department’s statewide alcohol/drug treatment activity database system. Data were compiled for King County residents from January 1, 1999, through June 30, 2004. Data are included for all treatment admissions that had any public funding. Department of corrections and private pay clients (primarily methadone) are also included, though they contribute only a small number of cases. Methadone waiting list data for those seen at syringe exchange sites are administered and provided by Public Health–Seattle & King County (PHSKC). • Drug-related mortality data were provided by the King County Medical Examiner (ME). Data for the first half of 2004 are preliminary. The data include deaths directly caused by licit or illicit drug overdose and exclude deaths caused by EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—Seattle-King County Area antidepressants in isolation and by poisons. Totals may differ slightly from drug death reports published by the King County ME’s office, which include fatal poisonings. Testing is not done for marijuana. Because more than one drug is often identified per individual drug overdose death, the total number of drugs identified exceeds the number of actual deaths. • School drug use survey data are available from the Seattle Public School’s Communities That Care Survey for 2002 and 2004. Response rates were 50 percent in 2002 and 60 percent in 2004. Trends cannot be determined from these data. • Syringe exchange data on the number of syringes exchanged and the number of encounters with clients are provided by PHSKC’s HIV/AIDS program. • Prescription drug sales data are extracted from the Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) reports. The data provide retail drug distribution data by Zip Code, covering primarily sales to hospitals and pharmacies. Data are unavailable for most drugs for year 2000. ARCOS data presented here are for the 3-digit Zip Code areas of 980 and 981, which roughly correspond with King County boundaries. The population in these two Zip Code areas is 1,969,348, compared with 1,737,034 for King County in 2000. • Illegal drug seizures data from the U.S. Customs Service relating to the seizures for all illegal drugs are included for January 2001 to June 2004. • Methamphetamine production data are from the Washington State Department of Ecology (DOE), which is mandated to respond to and document all “Methamphetamine Incidents,” including operating labs, dump sites, and other sites associated with the manufacture of methamphetamine. • Forensic drug analysis data are from the National Forensic Laboratory Information System (NFLIS), which distributes data from the Washington State Patrol’s Toxicology Laboratory on drug test results on local law enforcement seizures. These data include the top 25 drugs identified in fiscal year (FY) 2003 and FY 2004. Data are presented for the Seattle-area lab in comparison to the rest of the State. Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005
• Data on infectious diseases related to drug use, including the human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and hepatitis, were provided by two sources. One source is “HIV/AIDS Epidemiology Report.” Data on HIV and AIDS cases (including exposure related to injection drug use) in Seattle-King County, other Washington counties, Washington State (2001 through 2003), and the United States (2000 through 2002) are provided by PHSKC, the Washington State Department of Health, and the Federal Centers for Disease Control and Prevention (CDC). HIV cases were reported to PHSKC or the Washington Department of Health between 2000 and 2004. The Sexually Transmitted Disease (STD) Clinic, PHSKC, provided data on clients’ drug use, health status, and health behaviors for October 2001 to September 2002. • Drug-related helpline data are from the Washington State Alcohol/Drug Help Line (ADHL), which provides confidential 24-hour telephonebased treatment referral and assistance for Washington State. Data are presented for January 2001 to June 2004 for calls originating within King County. Data presented are for drugs mentioned. A caller may refer to multiple drugs; therefore, there are more drug mentions than there are calls. The data exclude information on alcohol and nicotine, which account for more than one-half of the calls. Data are presented primarily for illicit drugs only; prescription drugs have not been coded consistently over time, thus trend analyses are limited. The large number of unknown drugs in 2001 and 2002 may obscure some trends as well. • Key informant interview data are obtained from discussions with treatment center staff, street outreach workers, and drug users. DRUG ABUSE PATTERNS AND TRENDS Cocaine/Crack The proportion of treatment admissions involving cocaine (i.e., cocaine was mentioned as the primary, secondary, or tertiary drug of abuse at the time of entry into treatment) has declined slowly but steadily, from 45 percent of all admissions in 1999 to 37 percent in the first half of 2004 (exhibit 1). Cocaine use was uncommon among youth, accounting for approximately 3 percent of cocaine-involved treatment admissions from 1999 through the first half of 2004. Cocaine users appear to be an aging group, with the proportion of those age 45–54 increasing from 15 percent in 1999 to 24 percent in the first half of 2004. At the same time, the EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—Seattle-King County Area age group with the greatest proportion of admissions, 30–44-year-olds, declined from 64 to 52 percent of admissions. For treatment admissions in which cocaine was not the primary, secondary, or tertiary drug of abuse, 29 percent were female, while cocaine-involved admissions were 39 percent female on average over this timeframe. No changes in the proportion of female cocaine admissions were seen over time. African-Americans are disproportionately represented in the treatment data relative to their representation in the county, due largely to the fact that these data are almost entirely based upon publicly funded treatment admissions and African-Americans have a lower annual income on average in King County than Caucasians. Even accounting for this demographic fact, African-Americans entering treatment use cocaine at much higher levels than Caucasians. In the first half of 2004, 33 percent of cocaine-involved treatment admissions were African-American, compared to 15 percent among those admitted to treatment who did not use cocaine. The county is 5 percent African-American. Unweighted data accessed from DAWN Live! show that cocaine emergency department drug reports for drug abuse/other case types represented the largest proportion of illegal drugs: 36 percent (n=1,082) in the first half of 2004 (exhibit 2). Additionally, there were 124 drug reports for cocaine for those seeking detoxification/treatment. Demographics for drug abuse/other case types were as follows. A similar proportion of cocaine drug reports were female, 35 percent, as for all drugs including alcohol, prescription, and over-thecounter drugs, 37 percent. Cocaine drug reports involved patients who were generally older than those seen for any drug. Only 4 percent of cocaine drug reports were for those age 12–20, compared to 10 percent for all drugs. For cocaine drug reports, 38 percent were 35–44, compared with 30 percent for all drugs. DAWN unweighted data for presenting complaints are newly available. On average, for each person there were 1.47 complaints. Most common for cocaine were altered mental status (20 percent), identical to “all drugs” (exhibit 2), and psychiatric condition (24 percent), higher than the 18 percent for all drugs. Cocaine drug reports were less likely to involve abscess/cellulitis problems (7 percent) compared to all drugs (12 percent). Those with cocaine drug reports were more likely to be admitted to the psychiatric unit, 7 percent, than those with any other illicit drug type reported. Information on the route of administration was not documented for 72 percent of the unweighted cocaine ED drug reports, much higher than the 52 percent of all drug types for DAWN ED data. Still, some differences Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005 237
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NATIONAL INSTITUTE ON DRUG ABUSE EP
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Foreword This publication includes
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EPIDEMIOLOGIC TRENDS IN DRUG ABUSE
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2 EPIDEMIOLOGIC TRENDS IN DRUG ABUS
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Epidemiology of Drug Abuse: CEWG Ar
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• The city of Atlanta has become
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In the first 6 months of 2004, trea
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eports (exhibit 2), while African-A
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population) than in 2002 (17.2 per
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16 EPIDEMIOLOGIC TRENDS IN DRUG ABU
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data from the Drug Abuse Warning Ne
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than age 18, compared to 4 percent
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More often than not, marijuana use
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Solomon, L.; Flynn, C.; Muck, K.; e
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• Logan International Airport and
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In 2002, heroin/morphine was indica
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The FY 2004 racial distribution for
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• Emergency department (ED) drug
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monly mentioned secondary drug amon
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Between 2001 and 2003, the Illinois
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In the NIHU Study, 20 percent of pa
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Ecstasy remained available in most
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66 and analyzed by the Division of
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ounce in the Denver metropolitan ar
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18 at the time of admission to trea
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Injecting had been the most common
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alcohol; 651 involved alcohol-in-co
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The economy in Hawai'i, after a dec
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Methamphetamine remains the leading
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methamphetamine, representing 76.5
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Of interest in this chart is the ag
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98 weighted DAWN data released by S
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A total of 5,425 cocaine arrests wa
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data, however, rising from 1.5 perc
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According to NDIC, California and M
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and 15 items were identified as pse
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most frequently reported secondary
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esidents are living with advanced H
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112 EPIDEMIOLOGIC TRENDS IN DRUG AB
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(DAWN) that monitors emergency depa
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Beginning in 2003, SAMHSA’s natio
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65 percent were older than 34. The
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the 1,198 drug abuse ED reports in
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“Crystal” or smokeable methamph
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tion was injection (62.9 percent),
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included reports of ED cases involv
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From November 10 to 16, 2004, 18 me
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NFLIS between October 2003 and Sept
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from 12.2 percent in the first half
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156 2003. Anecdotal information on
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Brownsville, and El Paso. African-A
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ground economy, it was estimated th
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According to street interviews, mos
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that crack sells for about $28,000-
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Benloton, X-man, 911, Lean Back, Se
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DAWN ME mentions for marijuana-invo
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ecstasy. MDMA ED mentions may be st
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the deaths, while Whites constitute
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Page 202 and 203: ADHS/DBHS reported that more than o
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York and Miami (Pach et al. 2002).
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In 2003, heroin was the primary sub
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opolitan Police Department report t
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International Report
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Among GTC patients, marijuana was t
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Others (63.8 percent) were using a
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Panel on Methamphetamine Abuse: NID
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Appendix A New Drug Abuse Warning N
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DAWN LIVE! The new DAWN includes ca
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Participant List National Institute
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Janie B. Dargan, M.S.W. Policy Anal
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Martin P. Paulus, M.D. Associate Pr
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